Effectiveness of evidence-based medicine on knowledge, attitudes, and practices of family planning providers: a randomized experiment in Jordan

BACKGROUND Provider misconceptions and biases about contraceptive methods are major barriers to family planning access for women in low- and middle-income countries, including Jordan. Evidence-Based Medicine (EBM) programs aim to reduce biases and misconceptions by providing doctors with the most up-to-date scientific evidence on contraceptive methods. METHODS We evaluate the effects of an EBM program conducted in Jordan on private providers' knowledge, attitudes, and practices. Family planning providers randomly assigned to a treatment group were invited to attend a roundtable seminar on the injectable contraceptive Depot Medroxy Progesterone Acetate (DMPA), and to receive two 15 min one-on-one educational visits that reinforce the messages from the seminar. RESULTS There was low compliance with the EBM program. The study fails to detect an impact on providers' knowledge of DMPA's side effects or on reported clinical practices. There is suggestive evidence of a positive impact on providers' attitudes toward and confidence in prescribing the contraceptive to their patients. There is also evidence of positive selection into program participation. CONCLUSIONS We conclude that EBM may not be effective as a stand-alone program targeting a family planning method with a high level of provider and consumer bias. Evidence of positive selection into program participation underscores the importance of randomization to avoid overestimating the true effects of interventions. TRIAL REGISTRATION AEA RCT Registry, AEARCTR0000539 , 11/3/2014.